Hospital cafeterias get a failing grade
There aren’t enough healthy choices
Avoid fried foods, sugary drinks and empty calories. Load up on fruits, vegetables and water. That is a common prescription for a healthier lifestyle — but you often won’t find it reflected in the shelves and food trays of a hospital cafeteria.
A study of 39 hospitals in Southern California gave hospitals a low score for healthful practices in their food offerings. Overall, they received a score of 29% for their cafeterias and 33% for vending machines, based on the Hospital Nutrition Environment Scan, a tool developed to assess the consumer nutrition environment.1
For example, the researchers found that while most hospitals sell fresh fruit, only about half offered a non-fried vegetable on their hot entrée line. Few gave prominence to the most healthful items, such as baked chips and 100% juice.
"A hospital is a place where people go to get well, and nutrition is such a huge piece of the wellness component," says lead author Courtney Winston, DrPH, RD, CD, a registered dietician and certified diabetes educator. "Serving not-so-healthy food in the cafeteria is counterproductive."
There were some bright spots. About two-thirds (69%) of hospitals offered a salad bar, and they were about as likely (61%) to identify healthy foods with signs or icons. Almost all hospitals (95%) sold fresh fruit.
"There was one hospital that we visited that actually had a big produce stand at the end of their salad bar. They had everything from peaches to oranges and bananas and pears and apples," says Winston. "There were a few places that actually offered free fruit to the employees. In one place, it was right next to the cash register — show your employee ID and get free fruit."
But many of the hospital cafeterias operated like commercial food establishments, catering to tastes rather than health, the survey found. Only three hospitals (7.7%) offered special promotions or pricing to encourage the purchase of healthy items. Six hospitals (15%) sold no healthful items near the cashier, where customers often make impulsive purchases.
"There was one hospital we walked into that had floor to ceiling racks of potato chips right next to the cash register — family-sized bags," says Winston. "It just resembled more of a convenience store than a cafeteria that should be in a hospital setting."
The availability of fresh, local produce helped boost healthful options, she says. "I was really impressed by the number of hospitals that had local produce available," she says. "Some of them actually had signs that said The potatoes we had today came from such-and-such farm.’ That really creates that connection from farm to plate."
Large hospitals and those with contracted food service were more likely to have icons identifying healthy items and posted nutrition information. While nutrition analysis does take time, smaller hospitals could bring in a dietician to analyze the common menu choices that often alternate in a cafeteria, Winston suggests.
Hospitals performed slightly better in providing healthy options from vending machines. Some vending machines had a touch screen that could display nutritional information. Others sold only organic products. "That [vending] technology has really improved and has helped bolster the effort toward healthy eating," she says.
Gift shops had very poor food choices, Winston says. They are often revenue-generators — perhaps supporting a philanthropic cause — and offer gourmet chocolates and salty or sugary snacks.
By promoting healthy foods, hospitals can support employees in their efforts to lose weight or have a better diet, and they can send a message to patients and visitors, she says. "[Promoting] prevention and wellness is going to be mission critical for health care systems," she says.
1. Winston CP, Sallis JF, Swartz MD, et al. Consumer Nutrition Environments of Hospitals: An Exploratory Analysis Using the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops, 2012. Prev Chronic Dis 2013;10:120335. Available at www.cdc.gov/pcd/issues/2013/12_0335.htm.